Basic Information
| Provider Information | |||||||||
| NPI: | 1215291356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUTHERFORD | ||||||||
| FirstName: | MEGHANN | ||||||||
| MiddleName: | ANTONIAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | L.L.M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2820 WOODSLEE DR | ||||||||
| Address2: | #407 | ||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480734401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109556640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26184 OUTER DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481462084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133897525 | ||||||||
| FaxNumber: | 3133897510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2012 | ||||||||
| LastUpdateDate: | 07/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801094447 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.